Liver Stiffness measurement and other non invasive tools for Prediction of Oesophageal and Gastric Varices.

Background: Development of oesophagogastric varices is the most common sequalae that may occur in patients with liver cirrhosis. Non invasiveness has become a major goal in hepatology in the latter years. Several serum markers and imaging methods have been demonstrated to correlate well with fibrosis stage and degree of portal hypertension. So, these methods have been tried for the non invasive prediction of oesophageal and or gastric varices Objectives: To assess the accuracy of liver stiffness measurement , some laboratory indices and Doppler parameters in prediction of presence esophageal and/or gastric varices. Subjects and methods: This study was performed on 73 compensated cirrhotic patients at Zagazig University hospital from June 2013 to May 2015. Diagnosis of liver cirrhosis was based on history, clinical, laboratory and imaging data. Patients were divided into two groups; group A, patients with no varices and group B those with oesophageal varices. Patients with varices were subdivided into those with small varices and those with large varices. Also patients with gastric varices were recorded . Results: The most accurate parameters for prediction of presence of OV according to our study, were congestive index, TE and Lok score. The most accurate parameters for prediction of the presence of large OV in this study were portal blood flow, C.I. and Lok score .The most accurate parameters for prediction of the possibility of presence of gastric varices were AST/platelets ratio index, Splenic artery flow volume and Lok score Conclusion: TE is a good positive test for screening purpose of OV (sensitivity 93.3%), yet less good positive for OV size differentiation and possibility of presence of gastric varices (sensitivity 88.2% and 66.7% respectively). TE is not a good negative test to exclude patients from endoscopic screening for presence of OV, large OV and possibility of gastric varices (specificity 76.7, 69.2 and 79.1%) respectively.